Provider Demographics
NPI:1891840880
Name:HANZELIK, LYNNE COTTER (LAC, DIP OM)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:COTTER
Last Name:HANZELIK
Suffix:
Gender:F
Credentials:LAC, DIP OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28247 AGOURA RD
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-2403
Mailing Address - Country:US
Mailing Address - Phone:818-710-7693
Mailing Address - Fax:818-880-6369
Practice Address - Street 1:28247 AGOURA RD
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-2403
Practice Address - Country:US
Practice Address - Phone:818-710-7693
Practice Address - Fax:818-880-6369
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC-5637171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist